New hope for patients and challenges for the multidisciplinary arrhythmia team: a hybrid convergent approach for atrial fibrillation treatment.

2020 
BACKGROUND The published data suggest the important role of left atrial posterior wall and epicardial myocardial layers ablation in rhythm control therapy in patients with persistent, medical refractory atrial fibrillation (AF). However, the endocardial ablation is not always effective in transmural substrate modification. The alternative treatment option is minimally invasive hybrid approach (HABL) combining the strengths of surgical and catheter ablation.  Aim: This study aimed to assess the periprocedural safety, acute and long-term results of HABL for AF. METHODS This is a retrospective, single-center study of patients who underwent HABL using a minimally-invasive transabdominal approach between July 2009 and January 2020. Demographic, in-hospital data and 12-month follow-up results were obtained. The number of hospitalizations, cardioversions, re-ablations, and severe adverse events in a 3-year period before and after HABL were compared using national healthcare provider data. RESULTS In total, 158 patients (mean age, 51 years) who underwent HABL were included; 61.4% had persistent AF. There was a 4.4% incidence of periprocedural complications; without any fatalities. In 66% of patients, additional endocardial substrate modification was needed, in 52.6% on posterior wall. In the 12-month follow-up, most patients (78.3%) remained free of arrhythmias. There was a significant reduction in the number of hospitalizations (either for AF: 1.65 vs 0.54 or any other cause: 2.56 vs. 1.31 per patient), cardioversions, and re-ablations after HABL. CONCLUSIONS The hybrid, multidisciplinary approach for treatment of AF in safe and in long-term observation very effective treatment method, reducing healthcare burden and could be considered as an alternative therapeutic option especially in patients with persistent AF.
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